Sciatic Nerve Anatomy Video Video Transcript The sciatic nerve is the longest and largest nerve in the human body, running from the lower back through the back of the leg, and down to the toes. The sciatic nerve starts as a collection of nerve fibers in the lower spine. These nerve fibers, or roots, exit the spinal canal through a number of openings in the bones at each level of the lower spine called foramen. These lumbar nerve roots then combine to form one large nerve. The sciatic nerve is about as thick as a man's thumb at its largest point. The sciatic nerve travels through an opening in the pelvis called the greater sciatic foramen, and typically runs below the piriformis muscle. This is why piriformis muscle problems or spasm can lead to leg pain sciatica symptoms. The sciatic nerve then travels down the back of the upper thigh. Above the back of the knee, the sciatic nerve divides into two nerves, the tibial and the common peroneal nerve, both of which serve the lower leg and foot. Certain conditions in the lower back can irritate the sciatic nerve, causing pain to radiate along the nerve.

These symptoms are called sciatica , or lumbar radiculopathy. The complex anatomy of the sciatic nerve means that symptoms of sciatica vary depending on where this irritation occurs. Editor's Top Picks Sciatic Nerve Anatomy, Location & Diagram | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Sciatic nerve The sciatic nerve is the dominant nerve that innervates the lower back and the lower extremities. It travels from the lower spine, through the pelvis, and down each leg. It is the longest and widest nerve in the human body. The sciatic nerve primarily supplies the muscles of the lower leg, including the calf, ankle, and the back portion of the knee. It also supplies sensation to the sole of the foot, the ankle, the entire lower leg, and the back of the thigh. The sciatic nerve branches into different parts of the body along its path, hence its ability to supply such a large area of the body. It is a mixed-function nerve, meaning that it contains both sensory neurons and motor neurons.

This means that it simultaneously enables muscles to feel and to move. Damage to the sciatic nerve can result in numerous symptoms, including lower back pain, muscle weakness and reflex abnormalities. Although it can be damaged anywhere, symptoms are usually present in the lower leg, such as an inability to bend the knee, shooting pain from the buttocks to the lower leg, or difficulty in rotating and bending the foot. Sciatica - Causes, Symptoms, Treatment, Diagnosis - Canada.com Health Column The Facts Sciatica is a pain that shoots along the sciatic nerve, radiating through the buttocks and down the back of the leg and as far as the foot. The two sciatic nerves (one on each side of the lower body) are the longest in the human nervous system, running all the way from the lower back through the thighs and calves to the feet. Sciatica is caused by different types of pressure on the sciatic nerve in the lower back or buttocks. It can also be the result of damage to the nerve roots that feed into the sciatic nerve. Sciatica is usually felt only on one side of the body. The pain can occur along the entire length of the sciatic nerve.

Causes Pressure on the sciatic nerve can have many causes, some serious and some more minor. Sciatica may be the result of something as simple as bad posture, muscle strain or spasm, pregnancy, being overweight, wearing high heels, or sleeping on a mattress that is too soft. More seriously, it can result from pressure exerted on the sciatic nerve or its nerve roots by a slipped disc in the back. You may be at increased risk of sciatica if you have a job that involves heavy lifting, twisting your back, or sitting for lengthy periods of time. Age and diabetes also contribute to the risk. As you age, the discs in your back begin to deteriorate. Diabetes can increase the risk of nerve damage. In some cases, sciatica is due to nerve inflammation caused by a form of arthritis, or is caused by the squeezing of the sciatic nerve by a tumour wrapped around the spinal cord in the lower back (the lumbar spine). The spinal cord is a soft bundle of nerves that starts at the base of the brain and runs down the middle of the back. It is the main pathway for communication between the brain and the rest of the body. The cord is covered by the protective spinal column (the vertebrae).

Nerves enter and exit the spinal cord all the way down its length, passing through small openings between each vertebra. Nerve roots also stick out through these openings, exchanging nerve signals with the rest of the body. The vertebrae are separated from each other by discs made of cartilage, a substance like bone but softer. Each disc has a tough outside layer and a soft inside part that acts as a shock absorber, cushioning the vertebrae when the body moves around. If the disc is damaged by injury or through aging, the inner part can bulge or slip through the outer layer. The "extruded" or "herniated" inner part of the disc may then compress or inflame a nerve root sticking out between two adjacent vertebrae. The disc may even injure the nerve root. If this happens in the lower back area, it leads to pain travelling down the sciatic nerve in the leg. Osteoarthritis is another common source of nerve root damage that may cause sciatica. Osteoarthritis is characterized by the formation of bone spurs (bits of protruding bone) that may press on the nerve roots.

Sometimes, older people may also develop a condition called spinal stenosis, where the space around the spinal cord narrows and squeezes nerves. More rarely, infections like meningitis or spinal cord tumours can affect the nerves. It's also possible for the sciatic nerve to be compressed further outside the spinal column in the pelvis or buttocks. Symptoms and Complications The main symptom of sciatica is pain that radiates through the buttock and down the back of the thigh and leg. The pain may stop below the knee or continue right down to the foot. Pain from sciatica can change: it can be shooting or burning, sharp or dull, non-stop, or intermittent. Pain is usually only felt on one side of the body. Some people complain of intense and acute pain. Others experience a numb and weak feeling in the parts of their leg where it hurts. This may sometimes indicate more serious neurological problems. Sneezing, coughing, straining, bending, or lifting can make it worse. In rare cases, people suffering sciatica as a result of a slipped disc are confined to bed for a few days.

Another uncommon situation is disturbance of bowel and bladder control as a result of pressure on the nerves in the lower portion of the spine. Consult your doctor immediately if this occurs. Making the Diagnosis Symptoms will help a doctor make the diagnosis. Your doctor will check the spine for areas of tenderness. Tests for sensation, coordination, muscle strength, and reflexes may be performed, especially when a slipped disc is suspected. Your doctor may use the straight-leg-raise test (lifting the leg to an angle of more than 60 degrees without bending the knee) to help locate the point of pain. Other tests may include an X-ray, or scans like computed assisted tomography (CT or CAT) or magnetic resonance imaging (MRI). Treatment and Prevention Sciatica can be relieved by treating symptoms and any specific cause that exists, such as a slipped disc. Your doctor may prescribe muscle relaxants, pain relievers, or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Sometimes, symptoms may be decreased by using medications that decrease the efficiency of the nerves sending the pain message. Moderate exercise is recommended if pain is minimal. When the symptoms have lessened, therapy to strengthen abdominal muscles and back muscles is important to prevent a return of symptoms.

Here are some other things that may help. Many of them are similar to ways of dealing with other common lower back problems: Sleep on a firm mattress on your side or back with knees bent. During bad attacks, sleep with a pillow under or between your knees. Try not to sleep on your stomach. Muscle spasms may be treated by applying heat or cold to the affected area. Adjust the height of chairs so your feet are flat on the floor and the knees are a little higher than the hips. Keep your feet flat on the floor and do not cross your legs when sitting. Sit in chairs that have firm back support and sit up straight against the back of the chair. More on Body and Health See What You Need to Know About Sciatica Any problem in the lower spine can affect a nerve that feeds into the sciatic nerve, causing sciatica symptoms. Watch: Sciatica Animated Video Any problem in the lower spine can affect one of the nerves that feeds into the sciatic nerve, causing pain to radiate along that part of the nerve. The sciatic nerve supplies sensation and strength to the leg as well as the reflexes of the leg.

It connects the spinal cord with the outside of the thigh, the hamstring muscles in the back of the thighs, and muscles in the lower leg and feet. As such, when the sciatic nerve is impaired, it can lead to muscle weakness and/or numbness or tingling in the leg, ankle, foot, and/or toes. Watch: Sciatic Nerve Anatomy Video The sciatic nerve is actually made up of five nerves. It is formed on the right and left hand side of the lower spine by the combination of the fourth and fifth lumbar nerves and the first three nerves in the sacral spine. See Spinal Anatomy and Back Pain Each nerve exits the spine between two vertebral segments and is named for the segment above it. The nerve that exits the spine between lumbar segment 4 and lumbar segment 5 ( L4 and L5 ) is called the L4 nerve root, and the nerve that exits between the L5 and Sacral segment 1 is called the L5. The nerves that emerge from the sacral foramen include S1, S2, and S3.

Article continues below Watch: Sciatica Animated Video The five nerves group together on the front surface of the piriformis muscle (in the rear) and become one large nerve, the sciatic nerve. This nerve then travels down the back of each leg, branching out to provide motor and sensory functions to specific regions of the leg and foot. See Spinal Cord and Spinal Nerve Roots In the lower thigh/above the back of the knee, the sciatic nerve divides into two nerves, the tibial and peroneal nerves, which innervate different parts of the lower leg: Peroneal nerves. The peroneal nerves travel laterally (sideways) along the outer part of the knee and down into the upper foot. Tibial nerves. The tibial nerves continue to travel downward toward the feet and innervate the heel and sole of the foot. Because of the different nerve pathways, symptoms may present in different parts of the leg or foot depending on where the nerve is affected. Sciatic Nerve - Anatomy Pictures and Information Home > Nervous System > Nerves of the Leg and Foot > Sciatic Nerve Sciatic Nerve The sciatic nerve is the largest and longest spinal nerve in the human body.

Extending from the lumbar and sacral plexuses in the lower back, the sciatic nerve runs through the buttocks and into the thighs. It delivers nerve signals to and from the muscles and skin of the thighs, lower legs and feet. The sciatic nerve forms from the merger of the fourth and fifth lumbar nerves with the first, second, and third sacral nerves.... Move up/down/left/right: Click compass arrows Rotate image: Click and drag in any direction, anywhere in the frame Identify objects: Click on them in the image 2D Interactive 3D Rotate & Zoom Change Anatomical System Change View Angle Full Sciatic Nerve Description [Continued from above] . . . From the lower back, the sciatic nerve runs inferiorly into the gluteal region and into the posterior of the femoral region of the leg. Smaller individual nerves branch off from the sciatic nerve to innervate our thigh muscles and skin. At the inferior end of the femoral region, the sciatic nerve branches off into the tibial and common fibular nerves, which continue carrying nerve signals into the lower legs and feet.

Histology Like all spinal nerves, our sciatic nerve contains many individual neurons that run along the length of the nerve like strands of thread in a thick yarn. Each neuron is wrapped in a thin layer of connective tissue called the endoneurium. The neurons are bundled together into groups called fascicles, which are further wrapped by connective tissue called the perineurium. Many fascicles are bundled together to form the entire sciatic nerve, which is further wrapped by a sheet of connective tissue known as the epineurium. Blood vessels run between the fascicles to provide oxygen and nutrients to support the nerve cells and remove waste products. Physiology The sciatic nerve innervates many of the posterior muscles of the thighs directly and innervates the muscles of the lower legs and feet indirectly through its branches. Sensory neurons carrying signals from the skin of the hip and thigh also run through the sciatic nerve toward the spinal cord.

Prepared by Tim Taylor, Anatomy and Physiology Instructor Nerves of the Abdomen, Lower Back and Pelvis Home > Nervous System > Nerves of the Abdomen, Lower Back and Pelvis Nerves of the Abdomen, Lower Back and Pelvis The nervous system of the abdomen, lower back, and pelvis contains many important nerve conduits that service this region of the body as well as the lower limbs. This section of the nervous system features the most inferior portion of the spinal cord along with many major nerves, plexuses, and ganglia that serve the vital organs of the abdominopelvic cavity. As the spinal cord descends through the vertebral canal of the lower back, it tapers to a point known as the conus medullaris around the L2 vertebra.... Move up/down/left/right: Click compass arrows Rotate image: Click and drag in any direction, anywhere in the frame Identify objects: Click on them in the image 2D Interactive 3D Rotate & Zoom Change Anatomical System Female Full Nerves of the Abdomen, Lower Back and Pelvis Description [Continued from above] . . .

The actual point of tapering is dependent on an individual’s age and height as the spinal cord completes its longitudinal growth during infancy, long before the growth spurts of childhood and adolescence. From the conus medullaris many individual spinal nerves descend through the vertebral canal of the lumbar and sacral spine in a structure known as the cauda equina, which is Latin for “horse’s tail.” Each pair of spinal nerves in the cauda equina exits the vertebral canal at foramen between the vertebrae of the lumbar spine or in the sacrum. Upon exiting the vertebral canal, the spinal nerves of the lower back form into two networks known as the lumbar and sacral plexuses. The lumbar plexus supplies nerves to the skin and muscles of the lateral abdominal region, thigh, anterior thigh, and external genitals. The sacral plexus similarly supplies nerves to the skin and muscles of the posterior thigh, leg, and foot. The sciatic nerve, the largest and longest nerve in the human body, carries a major portion of the nerve signals from the sacral plexus into the leg before separating into many smaller branches.

The spinal nerves of the lower back also carry many neurons of the autonomic nervous system (ANS) that maintain the vital involuntary processes of the digestive, urinary, endocrine, and reproductive systems. Neurons from the sympathetic division of the ANS extend from the spinal cord to form nerves that meet at several autonomic ganglia in the abdomen. Each autonomic ganglion, such as the celiac ganglion, forms a plexus of nerve fibers that extend to the organs of the abdomen and pelvis to control their function. The parasympathetic division of the ANS is also represented in the abdomen and pelvis through the vagus nerve and the sacral nerves. The vagus nerve is a cranial nerve that wanders from the base of the brain parallel to the spinal cord to stimulate digestion in the liver, stomach, and intestines. Parasympathetic neurons in the spinal cord pass through the sacral nerves in the lower back to reach the pelvic organs such as the bladder and reproductive organs to control their functions. Between the opposing functions of the sympathetic and parasympathetic divisions of the ANS, the nervous system is effectively able to control all of the organs of the abdomen and pelvis.

A frequently overlooked portion of the nervous system is the enteric nervous system (ENS) found in the gastrointestinal tract. The ENS is a network of around 100 million neurons that regulate the functions of the digestive tract. The ENS monitors the contents of the gastrointestinal tract; decides how to digest its contents most effectively; and controls the movements of smooth muscles and the secretion of glands that results in the digestion of food to provide nutrients to the body. Although the brain is able to monitor and control the ENS through autonomic neurons, the ENS often works autonomously and can even function after its nervous connections to the brain have been destroyed. Prepared by Tim Taylor, Anatomy and Physiology Instructor Sciatica Pain Treatment, Symptoms, and Information | Back.com Sciatica (Pinched Nerve) Sciatica (Pinched Nerve) Sciatica, radiculopathy, and herniated discs go hand in hand. Learn the difference and find out how they are treated. What is Sciatica? Sciatica is not so much a condition but actually a symptom. It refers to pain that begins in the hip and buttocks and continues all the way down the leg.

This symptom is often accompanied by low back pain, which can be more or less severe than the leg pain. The term sciatica indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition. True sciatica is a condition that occurs when a herniated disc or osteoarthritic bone spurs compress and pinch one of the contributing roots of the sciatic nerve. This is known as a pinched nerve. This type of lower back pain is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica. The challenge for a physician is to distinguish between radicular pain (also called radiculopathy), which is caused by an inflamed nerve root, and referred pain, which is a result of a musculoskeletal sprain or strain. What is Radiculopathy? Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots.

The nerve roots are branches of the spinal cord that carry signals to the rest of the body at each level along the spine. This term comes from a combination of the Latin words radix, which means "roots of a tree", and pathos, which means "disease." This disease is often caused by direct pressure from a herniated disc or degenerative changes in the lumbar spine that cause irritation and inflammation of the nerve roots. Radiculopathy usually creates a pattern of pain and numbness that is felt in your arms or your legs in the area of skin supplied the by sensory fibers of the nerve root, and weakness in the muscles that are also supplied by the same nerve root. The number of roots that are involved can vary, from one to several, and it can also affect both sides of the body at the same time. What is a Herniated Disc? Herniation describes an abnormality of the intervertebral disc that is also known as a "bulging," "ruptured," or "torn" disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis).

This tear in the annulus fibrosis causes pain in the back at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve. Between each vertebra in the spine is a pair of spinal nerves, which branch off from the spinal cord to a specific area in the body. Any part of the skin that can experience hot and cold, pain or touch, refers that sensation to the brain through one of these nerves. In turn, pressure on a spinal nerve from a herniated disc will cause pain in the part of the body that is served by that nerve. Most disc ruptures occur when a person is in their 30s or 40s when the nucleus pulposus is still a gelatin-like substance. Four Degrees of Disc Herniation: Nuclear Herniation Sequestered Nucleus What Are the Symptoms of a Herniated Disc/Pinched Nerve? Usually, a person’s main complaint is back pain. In some cases, there may be a previous history of episodes of localized lower back pain, which is present in the back and continues down the leg that is served by the affected nerve.

This pain is usually described as a deep and sharp pain, which gets worse as it moves down the affected leg. The onset of pain with a herniated disc may occur out of the blue or it may be announced by a tearing or snapping sensation in the spine that is thought to be the result of a sudden tear of part of the annulus fibrosis. A person with a herniated disc will usually complain of lower back pain that may or may not radiate into different parts of the body. They will often have limited range of motion when asked to bend forward or lean backward, and they may lean to one side as they try to bend forward. Sometimes, they walk with a painful gait, flexing the affected leg so as not to put too much weight on the side of the body that hurts. How is a Herniated Disc/Pinched Nerve Diagnosed? A neurological history and examination performed by a trained physician will provide the most objective evidence of a herniated disc and pinched nerve. There are no laboratory tests that can detect the presence or absence of a herniated disc, but they may be helpful in diagnosing unusual causes of nerve root pain and irritation.

An EMG (electromyographic test) may help to determine which nerve root in particular is being pinched or is not working normally in the situation where several nerve roots may be involved. An MRI is the test of choice for diagnosing a herniated disc. How is a Herniated Disc/Pinched Nerve Treated? The treatment for the vast majority of people with a herniated disc does not normally include surgery. Many patients will respond to non-surgical treatments . The primary element of non-surgical treatment is controlled physical activity. Usually, treatment will begin with avoidance of exacerbating activities followed by a gradual return to normal activities. Sitting is bad for this condition because the sitting posture puts a large amount of stress and pressure on the lumbar spine, which may increase the pressure on the affected nerve root. The appropriate use of medications is an important part of non-surgical treatment. This can include anti-inflammatory drugs, analgesics, muscle relaxants, or tranquilizers. Additionally, the right doses of aspirin have been proven to help herniated discs. Physical therapy is also important.

Surgical treatment and chronic pain therapies are reserved for people who have not had success with non-surgical treatment options and a sufficient period of time has passed to indicate that they may need to have surgery in order to help them to get better. Sciatica | Sciatic Nerve Pain | Causes, Diagnosis, and Treatment of Sciatica Credits What is sciatica? Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve . The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. It goes down through the buttock, then its branches extend down the back of the leg to the ankle and foot. What causes sciatica? The most common cause of sciatica is a bulging or ruptured disc ( herniated disc ) in the spine pressing against the nerve roots that lead to the sciatic nerve. But sciatica also can be a symptom of other conditions that affect the spine , such as narrowing of the spinal canal ( spinal stenosis ), bone spurs (small, bony growths that form along joints) caused by arthritis , or nerve root compression ( pinched nerve ) caused by injury.

In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy . What are the symptoms? Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot. Weakness , tingling, or numbness in the leg may also occur. Sitting, standing for a long time, and movements that cause the spine to flex (such as knee -to-chest exercises) may make symptoms worse. Walking, lying down, and movements that extend the spine (such as press-ups ) may relieve symptoms. How is sciatica diagnosed? Sciatica is diagnosed with a medical history and physical exam . Sometimes X-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica. How is it treated? In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by: Avoiding sitting (unless it is more comfortable than standing). Alternating lying down with short walks . Increase your walking distance as you are able to without pain.

Sciatica Information & Definition | Sciatic Nerve Pain Treatments, Exercise & Relief Written by Stewart G. Eidelson, MD Sciatica is defined as a severe pain in a leg along the course of the sciatic nerve. The pain is felt in the back of the leg running from the buttock down the back of the thigh into the calf and foot. The pain may begin abruptly or gradually, and is characterized by a sharp, shooting, or electric shock-like quality. Movement of the extremity (ie, leg) often intensifies the pain. Pain may be uniformly distributed along the leg, but frequently there are certain spots where pain is more intense. Pain is often associated with numbness and/or tingling in the distribution of the sciatic nerve. Sciatica may result from any process which causes pressure or irritation of the nerve roots which compromise the sciatic nerve. This pressure may result from a variety of processes such as a ruptured intervertebral disc, narrowing of the bony spinal canal (called spinal stenosis), or rarely from infection or tumor. The sciatic nerve is the longest and largest nerve in the body; it measures three-quarters of an inch in diameter.

It originates in the sacral plexus; a network of nerves in the low back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine and the sacrum combined. The sciatic nerve and its nerve branches enable movement and feeling (motor and sensory functions) in the thigh, knee, calf, ankle, foot, and toes. The sciatic nerve and the lumbosacral spine is pictured below. About the Sciatic Nerve in the Low Back The sciatic nerve starts in your low back, which is called your lumbar spine. The nerve roots are at the L4 and L5 vertebrae (the 'L' means lumbar, and the numbers indicate the level of the vertebra—where it is in your back). The sciatic nerve also travels through your pelvic region (sacrum). In most people, the sciatic nerve runs under the piriformis muscle, which moves your thigh side to side. From there, the sciatic nerve descends through the buttocks and the back of the thighs. Behind your knee, smaller nerves branch out from the sciatic nerve and travel down to your feet.

Your sciatic nerve is part of a complex structure: your body's nervous system. That system is responsible for transmitting pain and sensation to other parts of your body. So, when something presses on a nerve, you'll feel it, and it won't feel good. With sciatica, something in your low back—a herniated disc, for example—compresses the sciatic nerve, which then transmits pain down your legs. The sciatic nerve exits the sacrum (pelvic area) through a nerve passageway called the sciatic foramen. At the upper part of the sciatic nerve, two branches form; the articular and muscular branches. The articular branch goes to the hip joint. The muscular branch serves the leg flexor muscles (muscles that enable movement). Other complex nerve structures are involved—the peroneal nerves and tibial nerves. The peroneal nerves originate from the nerve roots at the fourth and fifth lumbar spine (L4-L5) and first and second levels of the sacrum (S1-2). After the peroneal nerves leave the pelvis, they travel down the front and side of the leg, and along the outer side of the knee, to the foot.

The tibial nerves originate from the nerve roots at L4-5 and S1-3. The tibial nerves pass in front of the knee and downward into the foot (heel, sole, toes). If your sciatic nerve is compressed, it can cause pain along these pathways; that is how sciatic pain can "spread" or radiate to another part of your body. Popular Questions Asked and Answered What's causing my pain? Your sciatic nerve pain can be caused by a bulging disc or a herniated disc, degenerative disc disease, piriformis syndrome, pregnancy, spinal stenosis, a spinal tumor or spinal infection, spondylolisthesis, or trauma. Any one of those conditions can put pressure on the sciatic nerve or related nerve roots in your low back. That pressure is what causes your pain and other symptoms. Read our spine specialist-written article on 6 leading sciatica causes . Will I need surgery? Most patients with lumbar radiculopathy respond well to non-surgical treatments, so spine surgery is seldom needed to treat it. However, there are situations when you may want to go ahead with spine surgery: You have bowel or bladder dysfunction.

This is rare, but it may occur with spinal cord compression. You have spinal stenosis, and your doctor feels that surgery is the best way to treat it. You are experiencing other neurologic dysfunctions, such as severe leg weakness. Your symptoms become severe and/or non-surgical treatment is no longer effective. Read a detailed article on surgery to address sciatic nerve pain . What kinds of surgery are used for lumbar radiculopathy? Two common spinal surgeries for sciatica are: discectomy or microdiscectomy: In both of these procedures, the surgeon removes all or part of a herniated disc that's pushing on your sciatic nerve and causing your symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, you should recover more quickly from a microdiscectomy. laminectomy or laminotomy: These procedures both involve a part of the spine called the lamina—a bony plate that protects the spinal canal and spinal cord.

A laminectomy is the removal of the entire lamina; a laminotomy removes only a part of the lamina. These procedures can create more space for the nerves, reducing the likelihood of the nerves being compressed or pinched. Can I use over-the-counter medication to deal with my pain? Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) will help reduce swelling while relieving your pain. You and your doctor have plenty to choose from. You can use acetaminophen (eg, Tylenol), ibuprofen (eg, Advil), or naproxen (eg, Aleve). Sciatica Sciatica Article by John Miller What is Sciatica? Sciatica describes pain felt along the sciatic nerve, which runs from your lower back, down through the buttock, hamstrings and into the lower leg. The sciatic nerve is the longest nerve in the body. The spinal sections it originates from include L4, L5 or S1. Sciatica is commonly misdiagnosed, which can result is either slow or non-responsive treatment. Leg pain can have various sources. It can be a local leg injury or it may even be referred from your lower back.

The main nerve that travels from your lower back to your leg is your sciatic nerve. Irritation or pinching of your sciatic nerve can cause severe leg pain known as sciatica. Common Causes of Sciatica Pressure on the sciatic nerve from a herniated disc usually causes sciatica. Otherwise joint inflammation, compression of the nerve from bony arthritic growths or a locked facet joint in the lower spine can commonly cause sciatica. Leg pain can have various sources. Pain can be a local leg injury or it may even be referred from your lower back and travel along the sciatic nerve. The main nerve that travels from your lower back to your leg is your sciatic nerve. Injury that irritates or pinching of your sciatic nerve can cause severe leg pain known as sciatica. You're most likely to get sciatica when you're 30 to 50 years old. It may happen due to the effects of general wear and tear, plus any sudden pressure on the discs that cushion the vertebrae of your lower (lumbar) spine.

While there are numerous causes of sciatica, the most common are: sacroiliac dysfunction You're most likely to get sciatica when you're 30 to 50 years old. It may happen due to the effects of general spine wear and tear ( spondylosis ) or a traumatic injury that sudden pressure on the lumbar discs eg lifting, bending or sneezing. What are Sciatica Symptoms? Sciatica causes pain that usually begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain can vary between dull, aching or burning sensations and sharp, shooting pains. Sciatica can also cause tingling, numbness or muscle weakness in the affected leg. It is very important to seek medical attention in these situations as long-term nerve compression can permanently damage the nerve and its function. In these cases your symptoms may become permanent. One or more of the following sensations may occur because of Sciatica: Pain in the rear or leg that is worse when sitting Burning or tingling down the leg Weakness, numbness or difficulty moving the leg or foot A constant pain on one side of the rear calf A shooting pain that makes it difficult to stand up.

How is Sciatica Diagnosed? Sciatica is a clinical diagnosis based upon your symptom description, the behaviour of your pain and a thorough physical examination. While the diagnosis of sciatica is reasonably simple, the primary cause of your sciatica may require further investigations to eliminate or confirm its origin. It is also important to determine how significant your sciatic nerve has been compressed. Your physiotherapist will examine you, paying special attention to your spine and legs. In addition to asking you if you have low back pain that spreads to the leg and calf, your physiotherapist will test you for muscle weakness, sensation deficits and altered reflexes in your leg or foot. They will also want to know if you've had an injury, fever, problems controlling your bowels or bladder, previous cancers and whether you've been losing weight without trying. The answers to these questions are important because if these symptoms are present, the cause of sciatica could be a serious condition, such as a bone fracture, infection or cancer.

Your physiotherapist or doctor may send you for X-rays, or arrange for a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve. Most cases of sciatica affect the L5 or S1 nerve roots. Sciatica Treatment PHASE I - Pain Relief & Protection Managing your pain. Pain is the main reason that you seek treatment for sciatica. In truth, it was actually the final symptom that you developed and should be the first symptom to improve. Managing your inflammation. Inflammation is a normal part of your healing process post-injury. But, excessive inflammation can be the main cause of your sciatica. Please contact your physiotherapist or doctor for their professional opinion. PHASE II - Restoring Normal Flexibility, Posture & Strength As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back joint range of motion and resting muscle tension, lower limb muscle flexibility and posture. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

They may recommend that you undertake an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor. PhysioWorks has developed a Back Pain Core Stabilisation Program to assist their sciatica patients to regain normal core muscle control. Other more advanced programs can include stability exercises and equipment such as a Swiss exercise ball. Please ask your physio for their advice. Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body-weight in the buoyancy of water. This allows more movement without causing pain. PHASE III - Restoring Full Function & Dynamic Control The next stage of your rehabilitation is aimed at safely returning you to your desired activities. Everyone has different demands will determine what specific treatment goals you need to achieve. Your physiotherapist is the best person to guide your rehabilitation. PHASE IV - Preventing a Recurrence Sciatica does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. Fine tuning your back mobility and core control and learning self-management techniques will ultimately help you to achieve your goal of safely returning to your previous sporting or leisure activities without sciatica. Exercise is like cleaning your teeth. Exercise prevents problems.

Call PhysioWorks Book Online Surgery for Sciatica Surgery is occasionally required when your leg pain does not settle with a conservative (non-operative) approach. Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica. If you have some severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness you may require emergency surgery. Please check with your physiotherapist or doctor for their professional opinion. What is the Prognosis for Sciatica? Fortunately, sciatica usually eases after a short period of rest and avoiding aggravating activities. Everyone is different because of the various pathologies that cause sciatica, but 90% plus of sciatica suffers will be asymptomatic within six weeks. About one in every 50 people experiences sciatica as a result of a herniated disc. Of these, 10-25 percent has symptoms lasting more than six weeks. About 80-90 percent of people with sciatica get better, over time. All sciatica patients who suffer pain that lasts longer than six weeks should undertake a specific exercise regime to regain control of their symptoms in an effort to avoid spinal surgery.

Other Treatment Options Back Brace A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test eases your pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future. Back braces are available from PhysioWorks or via the following web link: Back Brace Massage Therapy Your spinal muscles will often present in muscle spasm, which responds favourably to soft tissue techniques such as massage therapy. You should seek the assistance of a quality remedial massage therapist to assist your sciatica treatment. Discover more about: Massage . Acupuncture Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture training. Find out more about: Acupuncture .

TENS Machine TENS machines are an electronic pain relieving device that will reduce your pain and your need for pain relieving drugs. More information can be found here: Tens Machine Swiss Exercise Ball The unstable surface that your Swiss Exercise Ball provides can help awaken your deep core stability muscles. Your physiotherapist can advise you specific exercises or you can download some exercise plans from the following web link: Ball Exercises Posture Supports Poor sitting posture is a common cause of sciatica. To assist the support of your lower back many simple and effective products have been developed over time. These include: Yoga When Should You Contact Your Physiotherapist? Contact your Physiotherapist if sciatica pain grows worse over a few days, or if it begins to interfere significantly with your daily activities. Call your physiotherapist or doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention. This condition can cause permanent damage if not quickly treated. Call PhysioWorks Book Online How to Prevent Sciatica?

If your life involves a lot of sitting, a back brace or an external ergonomic support such as a Lumbar Roll or Bassett Frame can be very useful in avoiding future bouts. Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it's always possible for your disk to rupture again. This happens to about five percent of people with sciatica. Once the pain of sciatica passes, there are strengthening and postural exercises, stretches and other measures that help prevent its return. Please contact your physiotherapist for specific advice. Here are some steps you can take in the meantime: Practice Good Posture. Stand up straight and stretch yourself upwards “trying to grow as tall as you can”. This will help to turn on your deep abdominal muscles that open the spaces in your spine where your nerves are vulnerable to pinching. Avoid Postures that Hurt. Depending on where your nerve is pinched, you may experience pain when sitting, standing, walking or even lying down. It is important to avoid whichever postures aggravate your pain. If it’s painful to sit for more than 5 minutes, limit your sitting to 4 minutes. Take regular breaks to stand and walk around.

If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day. Your body provides heaps of painful hints. Listen carefully and you will recover quicker. Walk/Swim. Walking and swimming can help to strengthen your lower back. Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back. Look up as you lift. Use Proper Sleeping Posture. Take pressure off your back by sleeping on your side or on your back with a pillow under your knees. If you don’t feel pain, you are in the right position. Avoid Wearing High Heels. Shoes with heels that are more than 1½ inches high shift your weight forward, excessively arches your back and can further pinch the sciatic nerve. For more advice about Sciatica, please contact your physiotherapist. Call PhysioWorks Book Online Why does Pinching a Nerve Hurt? Nerves have many functions, transmitting messages around the body, rather like a telephone system.

They allow us to feel things that happen to us, such as things we touch or that touch us, hot and cold, and pain, and they cause our body to do things, eg making your leg muscles contract when you want to walk. When a nerve is squashed, it may malfunction, and we might feel pain, numbness, pins and needles, and we might find our limbs are weak or do not work in the way they should. The nerve may also get inflamed and irritated by chemicals from the disc's nucleus, without surgery. Pressure on the sciatic nerve from a herniated disc usually causes sciatica. The problem is also termed a radiculopathy, meaning that a disc has protruded from its normal position in the vertebral column and is pinching the root (origin) of the sciatic nerve. The degree of pain is often "ridiculously" high as well. Less direct nerve pinching e.g. swelling around the nerve is usually a less severe dull ache. However, this can progress into a radiculopathy as swelling increases. Other things can cause irritation of or pressure on a nerve in the spine.

Sometimes this may be a rough and enlarged part of one of the bony vertebrae, brought about by ageing. Rarely, infections and tumours are to blame. Most times the cause is nothing too serious, but one of the reasons for seeing your physiotherapist or doctor if the pain persists is to exclude these serious and treatable causes. FAQs about Sciatica

Question: Running form the lower back down through the leg, which is the longest nerve in the human body?
Answer: SCIATIC NERVE